Key result
ICG angiography linked to ~59% lower anastomotic leak risk after colorectal surgery.
Why the study?
Systematic reviews of retrospective studies suggest indocyanine green reduces anastomotic leak, but outcomes needed evaluation comparing randomized controlled trials and retrospective studies.
Does indocyanine green angiography reduce anastomotic leak in patients undergoing colorectal surgery?
Meta-Analysis (n=8,291)
Does indocyanine green angiography reduce anastomotic leak in patients undergoing colorectal surgery?
Odds Ratio: 0.41 (95% CI 0.32–0.53)
p-value: p=<0.001
Retrospective studies overestimate the benefit of indocyanine green angiography on anastomotic leak and reoperation rates following colorectal surgery compared to randomized controlled trials.
Indocyanine green angiography may lower anastomotic leak risk in colorectal surgery; extends data but challenges effect magnitude given smaller RCT benefit.
Introduction Systematic reviews of retrospective studies suggest that indocyanine green (ICG) angiography reduces anastomotic leak (AL) and improves postoperative outcomes. This systematic review and meta-analysis evaluates colorectal surgery outcomes following ICG use with comparison of results found in randomized controlled trials (RCTs) and retrospective studies. Methods A systematic search was conducted of studies evaluating ICG in colorectal surgery with more than five patients. Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in August 2021 and this study followed PRISMA and MOOSE guidelines. Primary outcome was AL. Meta-analysis was conducted with RevMan 5.4. Results Overall, 2403 studies were retrieved with 28 total studies including three RCTs meeting criteria. RCTs included 964 patients, whereas other studies comprised 7327 patients with 44.6% receiving ICG. The ICG and non-ICG cohorts were similar with respect to age (62.6 vs 63.1 years), sex (45.1% vs 43.1% female), smoking (22.4% vs 25.3% smokers), and diabetes (13.4% vs 14.2%), respectively. Anastomotic height (6.5 vs 6.8 cm) and technique (78.7% vs 74.8% stapled) were also comparable. With retrospective studies included, ICG was associated with AL reduction (odds ratio [OR] 0.41; 95% CI, 0.32–0.53; p < 0.001) and reoperation for AL (OR 0.64; 95% CI, 0.43–0.95; p = 0.03), with pronounced effects for rectal anastomoses (OR 0.31; 95% CI, 0.21–0.44; p < 0.001). RCT evidence suggests a much smaller effect size (OR 0.64; 95% CI, 0.42–0.99; p = 0.04), and no reduction in AL reoperation (OR 0.72; 95% CI, 0.29–1.80; p = 0.48) or length of stay (LOS). Conclusion Retrospective studies suggest reduced AL, reoperation for AL, and LOS with ICG angiography. However, RCTs suggest a smaller effect size and do not demonstrate reduced reoperation or LOS. Additional RCTs are required before widespread ICG uptake.
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Verhoeff et al. (2022) conducted a meta-analysis in Colorectal surgery (n=8,291). Indocyanine green (ICG) angiography vs. Non-ICG was evaluated on Anastomotic leak (AL) (OR 0.41, 95% CI 0.32-0.53, p=<0.001). Indocyanine green angiography was associated with a reduction in anastomotic leak following colorectal surgery, though RCTs demonstrated a smaller effect size (OR 0.64) than retrospective studies.
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